Healthcare Provider Details

I. General information

NPI: 1851508667
Provider Name (Legal Business Name): SOUTH BAY SURGICAL AND SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 150
LONG BEACH CA
90807-2016
US

IV. Provider business mailing address

4300 LONG BEACH BLVD STE 150
LONG BEACH CA
90807-2016
US

V. Phone/Fax

Practice location:
  • Phone: 562-728-0230
  • Fax: 562-728-0237
Mailing address:
  • Phone: 562-728-0230
  • Fax: 562-728-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELLY ROSEKELLY
Title or Position: MANAGER
Credential:
Phone: 310-740-4933